Periods are often accompanied by a host of symptoms: the one universally recognized is pain. This pain is constantly dismissed by society as unimportant. However, this is a real and highly subjective issue, one that should be assessed for medical attention and acknowledged by society as the experience of many. 

Painful periods - What's the fuss about?

Sowmya Srinivasan is currently pursuing an undergraduate degree in Law honours from Tamil Nadu National Law University, Tiruchirapalli. They enjoy research and writing, and advocate for LGBT+ rights and mental health. They actively participate in debating, and when free, indulge in painting.

People with uteruses who are not pregnant experience monthly period bleeding for 2-5 days. This process, technically termed menstruation, involves the release of an unfertilised egg. It is often accompanied by several other symptoms, one of which manifests as severe pain. Medically termed dysmenorrhea, this pain can be caused by several factors.  In this article, I explore three types of issues that surround period pain: Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD) and endometriosis-related pain. 

 

PMS has an interesting history surrounding the term. In 1931, American gynaecologist Robert T. Frank authored “The Hormonal Causes of Premenstrual Tension”, which described the pain and other symptoms that accompanied monthly period bleeding. The usage of the word ‘tension’ is notable. It rendered the symptoms as almost casual and bearable, not as significantly impairing quality of life. At the same time, a significant wave of feminist psychology was gaining acceptance within mainstream medicine. Karen Horney, a female psychoanalyst, pushed for the recognition of this ‘tension’ as a disorder affecting the physical and mental health of individuals. Thus, the term Premenstrual Syndrome was coined in 1953 as a formal acknowledgement by the medical community of the physiological and psychological symptoms that accompanied periods. 

 

PMS symptoms such as fatigue, breast tenderness, headaches, and abdominal bloating are experienced to different degrees by different people. Some individuals suffer depressed moods, loss of libido, and social withdrawal as well. PMS pain can be of three types. Mild pain is characterised by physical symptoms such as cramps and stomach ache that still allows for normal day-to-day functioning.  Moderate pain necessitates some breaks from a person’s routine, and severe pain directly and significantly impedes a person’s social, occupational, and personal life. Experiences of PMS vary across individuals and time based on several characteristics. Changes in hormone levels of oestrogen and progesterone, changes in diet, weight, and lifestyle all affect a person’s experience of PMS. 

 

Premenstrual dysphoric disorder (PMDD) is a severe version of PMS that impairs a person’s quality of life. Symptoms begin a couple of days prior to ovulation continue into the period of bleeding and after. The intensity of pain is differentiated in PMDD as individuals experience dysphoria. Dysphoria indicates a profound sense of unease or dissatisfaction, accentuated by anxiety, restlessness, and irritability. PMDD symptoms are more severe than PMS, but PMDD is hard to diagnose and sometimes confused with depression. However, the acute rise of PMDD symptoms matches individuals’ monthly cycle, while depression does not follow the same pattern. The exact cause of PMDD is unknown, but it is correlated with hormonal changes experienced during menstrual cycle. In diagnosing PMDD, two common manuals are referenced: the DSM-5 (used by the American Psychiatric Association) and the ICD-10 (commonly used in India). While the DSM-5 manual refers to PMDD as a disorder, ICD-10 does not. 

 

The historic study of period pain, owing to gender disparities and biases in the medical field, often features studies by men evaluating the degree of pain experienced during a menstrual cycle. It’s also common, particularly for women with pelvic and menstrual pain to be told their pain is just a normal part of being a woman. The lack of research into these issues is also significant and indicates gender bias. There are five times as many studies into erectile dysfunction (ED) as premenstrual syndrome (PMS), even though only 1 in 5 men suffer from ED but 90 percent of all women experience some form of PMS.

 

One of the most common symptoms of endometriosis (a disorder where uterine tissue grows outside the uterus) is severe pain during monthly periods of bleeding. It is also characterised by excessive bleeding, fatigue, and nausea. Women with endometriosis are also at risk of infertility and ectopic pregnancies. While this pain is quite severe, all experiences of severe period pain do not indicate an endometriosis diagnosis. Endometriosis can be definitively diagnosed through exploratory laparoscopy, although other ultrasonic and physical tests may also be used. Other diagnoses consistent with endometriosis symptoms include adenomyosis, uterine fibroids and PCOD; consulting with an experienced gynaecologist is essential, therefore.

 

Stigma surrounding period pain conversations is rooted in heteronormative and cultural gender roles. Growing up, individuals suffering from period pain are often diminished and taught to  keep these issues ‘secret’. Internalised shame and fear of social ostracism leads to discussions on these critical topics existing predominantly in hushed conversations. Better information dissemination on the symptoms that accompany periods equips those experiencing pain to seek out help that they may need. 

 

An increased focus on conversations around period pain, and an acknowledgement of the subjective experiences that different people face can enable many to face this reality with the psychosocial support and medical attention that they require.

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